title: The utility of routine follow-up procedures in the surveillance of uterine cancer: a 20-year institutional review.
abstract: OBJECTIVE
  The purpose of this study was to assess the value of routine follow-up procedures during uterine cancer surveillance and the corresponding cost throughout a 20-year period at a single medical institution.
  
  
  METHODS
  We sought to determine which surveillance method (CA-125, imaging, physical examination or vaginal cytology) detected the highest number of patient recurrences and the corresponding cost vis-à-vis the number of identified progressive disease cases.
  
  
  RESULTS
  Serial imaging detected the highest number of progressive disease cases but the cost was rather high (USD 17,174 per patient recurrence), whereas CA-125 testing was the least expensive (USD 6,810 per patient recurrence). We also found that those with a variant histology [for example, adenosquamous and uterine papillary serous carcinoma (p < 0.001) and advanced (III/IV) disease stage (p = 0.001)] were associated with an unfavorable progression-free interval.
  
  
  CONCLUSIONS
  In the present investigation, serial imaging detected the highest number of progressive disease cases, although no single surveillance method was associated with a sensitive recurrent disease detection rate. Nevertheless, the CA-125 assay appeared to be the most cost-effective method in following patients with epithelial uterine malignancies. Thus, in the context of high-risk disease, a combination of procedures may still be necessary for optimal uterine cancer patient follow-up.
authors.affiliation: UCLA College of Letters and Science, Los Angeles, Calif., USA.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Rettenmaier
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Rettenmaier
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wojciechowski
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Abaid
authors.forename: John V
authors.initials: JV
authors.lastname: Brown Iii
authors.forename: John P
authors.initials: JP
authors.lastname: Micha
authors.forename: Bram H
authors.initials: BH
authors.lastname: Goldstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018394:CA-125 Antigen / Q000378:metabolism; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis*; D002291:Carcinoma, Papillary / Q000175:diagnosis*; D003365:Costs and Cost Analysis; D018284:Cystadenocarcinoma, Serous / Q000175:diagnosis*; D003581:Cytodiagnosis; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D018394:CA-125 Antigen